1. Field of the Invention
The present invention relates to surgical devices utilized for surgical procedures and incorporating liquid jets to assist manipulation of tissue and/or to manipulate tissue, and, more particularly to surgical devices utilizing high pressure liquid jets to cut tissue and/or drive mechanical tissue cutting components and/or remove or assist in removal of tissue from a surgical site.
2. Description of the Related Art
Surgery, especially surgery in confined spaces surrounded by delicate tissue, is very difficult to perform and requires a great degree of skill on the part of a surgeon and specialized surgical instruments. Tissue removing or manipulating surgical instruments traditionally utilized in such procedures often include specialized cutting, scooping, grasping, etc. components having particular shapes and orientations configured for specific surgical purposes. Examples of challenging surgical environments requiring specialized instruments include joints, the nasal cavity, the throat, the skull, the male and female urinary and reproductive tract, etc. One particularly challenging environment is the spine, where access to the vertebral disc often requires removal of fibrous cartilaginous tissue and vertebral bone while avoiding contact with the spinal cord, and nerves, veins and arteries embedded within or adjacent to the spinal column.
While a variety of tissue cutting/removal instruments can be utilized in one or more of the above-mentioned surgical environments, most such instruments can generally be classified as those whose tissue cutting/removal component is stationary with respect to the rest of the instrument and those with sliding, rotating, or otherwise movable tissue manipulating components. While each class includes many instruments, for illustrative purposes, the term “curette” will be utilized to represent the former class and the term “rongeur” will be utilized to represent the later class. As will be apparent to those skilled in the art based on the description of the invention to follow, many other traditional surgical instruments share one or more of the shortcomings discussed below and would benefit from the disclosed invention.
A curette is a well-known surgical device typically comprising a handle and a cup-shaped or ring-shaped distal operating end, typically with sharpened, tissue-cutting edges (see FIG. 1). In use, a curette is typically dragged across and/or pushed into tissue to score and remove tissue. In certain applications, a curette is used to remove a softer superficial layer or quantity of tissue from a harder tissue, such as bone. An example of use in surgery includes the scraping of cartilage from bony surfaces of the spine to promote fusion of a disc implant to vertebrae.
When typical conventional curette devices are employed, the surgeon, upon excising a piece of tissue, must usually remove the entire instrument from the surgical area and remove the excised tissue from the instrument prior to reinsertion of the instrument into the surgical area to excise more tissue. Such a process is tedious, fatiguing to the surgeon, and exposes the patient to an increased risk of damage to delicate tissues within the surgical area.
Thus, while the basic shape and function of the conventional curette, and similar instruments, is desired by many surgeons for many purposes, an improved means of facilitating tissue removal from the surgical site and/or improved tissue cutting for such instruments is desirable.
A rongeur is an instrument, typically for excising hard tissue, such as cartilage and bone, often characterized by distal end including a mechanical cutting or punching component actuatable by manipulating the handle of the instrument, e.g. by squeezing, scissor action, etc. Many rongeurs and bone punches utilized for spine surgery are configured to include a tube having a sharpened distal end that is longitudinally moveable to contact the proximal side of a bone/tissue protrusion and cut/snip/punch the protrusion upon actuation with the handle (see FIG. 12). If bone or cartilage is present between the tube and the protrusion, it can be cut and locally retained, with sufficient precision that damage to adjacent tissue, particularly the spinal cord, can reliably be avoided. However, the cut piece of bone or other tissue cannot safely be released inside the confines of the spine. Hence, the instrument must be removed after each cut; the cut piece deposited appropriately; and the instrument re-inserted. This makes the removal of tissue time-consuming, tedious, and physically demanding for the surgeon, particularly in terms of fatigue of the hand and also increases trauma to the patient and increases the risk of damage to sensitive surrounding tissue. Similar considerations apply in surgery of the skull, or in surgery adjacent to nervous tissue in any area of the body, particularly when involving removal of mechanically strong tissues such as bone, cartilage or calcified tissue. Great delicacy and precision are also required in other types of surgery, including surgery of the reproductive tract, the urinary tract, the upper respiratory system including the nose and the sinuses, the visual system, and the auditory system. Thus, there is a need for improved means of providing for tissue removal and/or tissue cutting for these and similar instruments.
In addition, other conventional, powered tissue removal instruments, such as drills and rotary cutting burrs, etc. are not generally considered sufficiently safe for use in many of the above-mentioned challenging surgical environments, since any operator error using conventional forms of such devices can result in damage to the spinal cord, nerves, blood vessels, or other delicate tissues of the patient. There is a need for instruments that can reliably remove tissue in proximity to delicate tissue, as described above, with greater speed, efficiency, and less trauma to the patient, and with less physical stress on the surgeon's hand and forearm musculature.